DE29623990U1 - Systeme für eine elektrochirurgische myokardiale Revaskularisation - Google Patents

Systeme für eine elektrochirurgische myokardiale Revaskularisation

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Publication number
DE29623990U1
DE29623990U1 DE29623990U DE29623990U DE29623990U1 DE 29623990 U1 DE29623990 U1 DE 29623990U1 DE 29623990 U DE29623990 U DE 29623990U DE 29623990 U DE29623990 U DE 29623990U DE 29623990 U1 DE29623990 U1 DE 29623990U1
Authority
DE
Germany
Prior art keywords
electrode
shaft
adjacent
reflux
electrode connection
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
DE29623990U
Other languages
English (en)
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Arthrocare Corp
Original Assignee
Arthrocare Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Arthrocare Corp filed Critical Arthrocare Corp
Publication of DE29623990U1 publication Critical patent/DE29623990U1/de
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Claims (46)

1. Elektrochirurgische Vorrichtung für die myokardiale Revaskularisation des Herzge­ webes eines Patienten, wobei die Vorrichtung aufweist:
  • - einen Katheterschaft (206), welcher für eine endoluminale Zufuhr in die Ventrikluarkammer des Patienten konfiguriert bzw. ausgebildet ist und proxi­ male und distale Endabschnitte aufweist und einen Elektrodenanschluss (58) aufweist, welcher auf dem distalen Endabschnitt angeordnet ist;
  • - einer Rückflusselektrode (56); und
  • - einer Hochfrequenz-Energie- bzw. Leistungszufuhr (28) zum Anlegen einer Spannungsdifferenz zwischen der Rückflusselektrode (56) und dem Elektroden­ anschluss (58), wobei die Spannungsdifferenz und der resultierende Strom aus­ reichend sind, um das maßanalytische bzw. volumetrische bzw. das auf das Volumen bezogene Entfernen des Herzgewebes benachbart zu bzw. angrenzend an den Elektrodenanschluss zu bewirken.
2. Vorrichtung nach Anspruch 1 weiter aufweisend eine Verbindungs- bzw. Konnektor­ vorrichtung (19), welche nahe dem proximalen Endbereich bzw. Endabschnitt des Schaftes angeordnet ist, zum elektrischen Koppeln des Elektrodenanschlusses mit der Hochfrequenz-Leistungszufuhr.
3. Elektrochirurgische Vorrichtung zur myokardialen Revaskularisation des Herzgewe­ bes eines Patienten, wobei die Vorrichtung aufweist:
  • - einen Katheterschaft (206), welcher für eine endoluminale Zufuhr in die ventri­ kuläre Kammer des Patienten konfiguriert bzw. ausgebildet ist und proximale und distale Endabschnitte aufweist und einen Elektrodenanschluss (58) aufweist, welcher auf dem distalen Endabschnitt angeordnet ist;
  • - eine Verbindungs- bzw. Konnektorvorrichtung (19), welche nahe dem proxima­ len Endabschnitt des Schaftes angeordnet ist zum elektrischen Koppeln des E­ lektrodenanschlusses mit einer Hochfrequenz-Leistungszufuhr zum Anlegen ei­ ner Spannungsdifferenz zwischen einer Rückflusselektrode und dem Elektroden­ anschluss, wobei die Spannungsdifferenz und der resultierende Strom ausrei­ chend sind, um das maßanalytische bzw. volumentrische Entfernen von Herz­ gewebe angrenzend an bzw. benachbart zu dem Elektrodenanschluss zu bewir­ ken.
4. System mit einer elektrochirurgischen Vorrichtung nach Anspruch 3 und der Hochfre­ quenz-Energie- bzw. Leistungszufuhr.
5. Vorrichtung nach Anspruch 3 oder 4 weiter aufweisend die Rückflusselektrode.
6. Vorrichtung nach einem der vorhergehenden Anspruche, wobei das distale Ende des Schaftes zum Fortschreiten bzw. Fortbewegen in einen Raum, welcher von dem ent­ fernten Herzgewebe freigemacht wurde, bemessen ist.
7. Vorrichtung nach Anspruch 6, wobei der Raum ein Revaskularisationskanal ist, wel­ cher durch mindestens einen Teil der Herzwand ausgebildet ist.
8. Vorrichtung nach Anspruch 7, wobei der Revaskularisationskanal eine maximale late­ rale bzw. seitliche Dimension bzw. Abmessung von 2,0 mm aufweist.
9. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei die Energie- bzw. Leistungszufuhr eine ausreichende Hochfrequenzspannung zwischen dem Elektroden­ anschluss und der Rückflusselektrode anlegt, um die Revaskularisation des myokardi­ alen Gewebes in dem Bereich der Zielstelle zu fördern.
10. Vorrichtung nach einem der vorhergehenden Ansprüche mit einem Elektroden-Feld bzw. Elektroden-Array, welches bei oder nahe dem distalen Ende des Schaftes ange­ ordnet ist und eine Mehrzahl von elektrisch getrennten bzw. isolierten Elektrodenan­ schlüssen umfasst, wobei ein Stromfluss von mindestens zwei der Elektrodenanschlüs­ se unabhängig gesteuert bzw. geregelt wird, basierend auf einer Impedanz zwischen dem Elektrodenanschluss und der Rückflusselektrode.
11. Vorrichtung nach Anspruch 10, wobei die Elektrodenanschlüsse in eine isolierende Matrix (48) eingebettet bzw. angeordnet sind, um jeden Anschluss elektrisch zu tren­ nen bzw. zu isolieren, wobei die isolierende Matrix ein anorganisches Material auf­ weist.
12. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei die maximale seitliche bzw. laterale Dimension bzw. Abmessung des distalen Endabschnittes des Schaftes weniger als ungefähr 1,0 mm beträgt.
13. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei die Rückflusselektro­ de auf dem Schaft vorgesehen ist.
14. Vorrichtung nach Anspruch 13, wobei die Rückflusselektrode auf der Sonde und pro­ ximal bzw. nahe zurück versetzt bzw. vertieft von dem Elektrodenanschluss angeord­ net ist.
15. Vorrichtung nach Anspruch 13, wobei die Rückflusselektrode und der Elektrodenan­ schluss auf einer distalen Oberfläche des Schaftes angeordnet sind.
16. Vorrichtung nach Anspruch 13 mit einem Feld von Rückflusselektroden auf einer distalen Oberfläche des Schaftes und mit einer entgegengesetzten Polarität bezüglich der Elektrodenanschlüsse.
17. Vorrichtung nach einem der Ansprüche 1 bis 12, wobei die Rückflusselektrode ein streuendes bzw. dispersives Kontaktelement (pad) im Kontakt mit einer äußeren Kör­ peroberfläche des Patienten ist.
18. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend einen Füh­ rungskatheter mit einem flexiblen bzw. biegbaren lenk- bzw. steuerbaren Schaft zum Zuführen des Katheterschaftes durch eine perkutane Penetration entlang eines endolu­ minalen Traktes bzw. Bahn in die ventrikuläre Kammer.
19. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend eine Mehrzahl von Impedanzüberwachungsvorrichtungen bzw. Impedanzmonitoren, welche mit den Elektrodenanschlüssen gekoppelt sind, zum Bestimmen der Impedanz zwi­ schen jedem einzelnen Elektrodenanschluss und der Rückflusselektrode.
20. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend ein Fluid- bzw. Flüssigkeits-Zufuhrelement (83) mit einer Öffnung benachbart bzw. angrenzend an dem Elektrodenanschluss zum Zuführen einer elektrisch leitfähigen Flüssigkeit bzw. Fluids (50) zwischen dem Elektrodenanschluss und dem Herzgewebe des Pati­ enten.
21. Vorrichtung nach Anspruch 20, wobei das Fluid-Zuführ-Element so konfiguriert ist, dass ein Stromflussweg zwischen dem Elektrodenanschluss und der Rückflusselektro­ de erzeugt wird.
22. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend einen Flu­ id-Hohlraum (lumen) (57) innerhalb des Schaftes zum Zuführen eines elektrisch lei­ tenden bzw. leitfähigen Fluids bzw. Flüssigkeit zu dem Elektrodenanschluss, wobei der Fluidhohlraum in Fluidverbindung steht bzw. fluidgekoppelt ist mit der Rückfluss­ elektrode und dem Elektrodenanschluss.
23. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei das elektrisch leitfähi­ ge Fluid Saline bzw. Salzlösung aufweist bzw. enthält.
24. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei das elektrisch leitfähi­ ge Fluid Blut oder andere Fluide bzw. Flüssigkeiten aufweist, welche innerhalb der Herzwand vorliegen.
25. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend einen Saughohlraum (282) innerhalb des Schaftes zum Entfernen von gasförmigen Produk­ ten der Abtragung bzw. Ablösung von der Zielstelle.
26. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend eine Füh­ rungsvorrichtung (310; 350), welche mit dem Instrumentenschaft gekoppelt ist, zum Bestimmen eines Endpunktes für den Revaskularisationskanal.
27. Vorrichtung nach Anspruch 26, wobei die Führungsvorrichtung eine die Wand wahr­ nehmende bzw. erfassende Vorrichtung (310) aufweist zum Bestimmen der Dicke der Herzwand.
28. Vorrichtung nach Anspruch 26, wobei die Führungsvorrichtung ein faseroptisches Betrachtungskabel (356) innerhalb des Instrumentenschaftes aufweist, und einen Gene­ rator (358) für sichtbares Licht, zur Beleuchtung einer Zielstelle auf der Herzwand.
29. Vorrichtung nach Anspruch 26, wobei die Führungsvorrichtung ein Ultraschall- Führungssystem (310) aufweist, welches konfiguriert bzw. ausgelegt ist, um Schall­ wellen auf die Herzwand zu übertragen, um eine Dicke der Herzwand zu bestimmen.
30. Vorrichtung nach Anspruch 26, wobei die Führungsvorrichtung einen Sensor (319) für eine elektrische Impedanz aufweist zum Detektieren bzw. Erfassen einer elektri­ schen Impedanz einer Struktur benachbart zu bzw. angrenzend an der aktiven Elektro­ de.
31. Vorrichtung nach Anspruch 26, wobei die Führungsvorrichtung einen Impedanz- Mess-Schaltkreis aufweist, welcher eine oder mehrere Impedanz-Überwachungs­ vorrichtungen bzw. -Monitore aufweist, welche mit dem Elektrodenanschluss gekop­ pelt sind, zum Bestimmen der elektrischen Impedanz zwischen dem Elektrodenan­ schluss und der Rückflusselektrode.
32. Vorrichtung nach einem der vorhergehenden Ansprüche weiter aufweisend eine me­ chanische Begrenzung (352) zum Einstellen der maximalen Bewegungsentfernung bzw. Vorschubdistanz des Elektrodenanschlusses durch das Herzgewebe.
33. Elektrochirurgische Vorrichtung für eine myokardiale Revaskularisation des Herzge­ webes eines Patienten, wobei die Vorrichtung aufweist:
  • - einen Schaft (206), welcher für eine interkostale Zufuhr in die Brusthöhle des Patienten benachbart zu bzw. angrenzend an das Epicardium konfiguriert bzw. ausgelegt ist und proximale und distale Endabschnitte aufweist und einen Elekt­ rodenanschluss (58) aufweist, welcher auf dem distalen Endabschnitt angeordnet ist;
  • - einer Rückflusselektrode (56); und
  • - einer Hochfrequenz-Energie- bzw. Leistungszufuhr (28) zum Anlegen einer Spannungsdifferenz zwischen der Rückflusselektrode und dem Elektrodenan­ schluss, wobei die Spannungsdifferenz und der resultierende Strom ausreichend sind, das maßanalytische bzw. volumetrische bzw. auf das Volumen bezogene Entfernen von Herzgewebe angrenzend an bzw. benachbart zu dem Elektroden­ anschluss zu bewirken.
34. Vorrichtung nach Anspruch 33 weiter aufweisend eine Verbindungs- bzw. Konnektor­ vorrichtung (19), welche nahe dem proximalen Endabschnitt des Schaftes angeordnet ist zum elektrischen Koppeln des Elektrodenanschlusses mit der Hochfrequenz- Energie- bzw. Leistungszufuhr.
35. Elektrochirurgische Vorrichtung für eine myokardiale Revaskularisation des Herzge­ webes eines Patienten, wobei die Vorrichtung aufweist:
  • - einen Schaft (206), welcher für eine interkostale Zufuhr in die Brusthöhle des Patienten, benachbart zu bzw. angrenzend an das Epicardium konfiguriert bzw. ausgelegt ist und proximale und distale Endabschnitte aufweist und einen Elekt­ rodenanschluss (58) aufweist, welcher auf dem distalen Endabschnitt angeordnet ist;
  • - einer Verbindungs- bzw. Konnektorvorrichtung (19), welche nahe dem proxi­ malen Endabschnitt des Schaftes angeordnet ist zum elektrischen Koppeln des Elektrodenanschlusses mit einer Hochfrequenz-Energie- bzw. Leistungszufuhr zum Anlegen einer Spannungsdifferenz zwischen einer Rückflusselektrode und dem Elektrodenanschluss, wobei die Spannungsdifferenz und der resultierende Strom ausreichend sind, um eine elektrisch leitfähige Flüssigkeit zu verdampfen und eine Ionisierung innerhalb der Verdampfungs- bzw. Dampfschicht zu verur­ sachen, um das maßanalytische bzw. volumetrische bzw. auf das Volumen be­ zogene Entfernen von Herzgewebe benachbart zu bzw. angrenzend an den E­ lektrodenanschluss zu bewirken.
36. System mit einer elektrochirurgischen Vorrichtung nach Anspruch 35 und der Hoch­ frequenz-Energie- bzw. Leistungszufuhr.
37. Vorrichtung nach Anspruch 35 oder 36 weiter aufweisend die Rückflusselektrode.
38. Vorrichtung nach einem der Ansprüche 33 bis 37, wobei die Rückflusselektrode auf dem Schaft befestigt bzw. montiert ist.
39. Vorrichtung nach einem der Ansprüche 33 bis 38, wobei der distale Endabschnitt be­ messen ist zum Fortschreiten bzw. Einführen in einem Revaskularisationskanal, wel­ cher in das Herzgewebe gebohrt ist.
40. Vorrichtung nach einem der vorhergehenden Ansprüche, welche angeordnet ist, um die elektrisch leitfähige Flüssigkeit zu verdampfen und eine Ionisation zu verursachen innerhalb der Verdampfungs- bzw. Dampfschicht, um das volumetrische Entfernen zu bewirken.
41. Vorrichtung nach einem der vorhergehenden Ansprüche, welche ausgelegt bzw. ange­ ordnet ist, um Energie 0,1 bis 3 mm nach vorne bzw. an der Vorderseite der aktiven Elektrode zu richten.
42. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei die Fläche des Elekt­ roden-Feldes bzw. Elektroden-Arrays in dem Bereich von 0,25 bis 20 mm2 liegt.
43. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei die Umhüllende bzw. Enveloppe oder der effektive Durchmesser von einzelnen Elektroden von 0,05 bis 3 mm reicht.
44. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei das Elektroden-Feld einen im wesentlichen kreisförmigen Querschnitt aufweist mit einem Durchmesser in dem Bereich von 0,3 mm bis 4 mm.
45. Vorrichtung nach einem der vorhergehenden Ansprüche, wobei die Elektrode in einer keramischen oder Glas-Trägermatrix verankert bzw. angeordnet ist.
46. Vorrichtung nach Anspruch 13 oder jedem Anspruch, welcher davon abhängt, mit einer isolierenden Umhüllung bzw. Futter um die Rückflusselektrode.
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US5810764A (en) 1998-09-22
EP0865256B1 (de) 2003-03-19
EP0865256A4 (de) 1998-10-07
US7422585B1 (en) 2008-09-09
CA2237795A1 (en) 1997-05-29
US5860951A (en) 1999-01-19
NZ323589A (en) 1999-07-29
US5683366A (en) 1997-11-04
US6113597A (en) 2000-09-05
US6032674A (en) 2000-03-07
ATE234592T1 (de) 2003-04-15
DE69626841T2 (de) 2003-12-18
EP1179320A2 (de) 2002-02-13
US5873855A (en) 1999-02-23
AU1057197A (en) 1997-06-11
JP3033848B2 (ja) 2000-04-17
EP0865256A1 (de) 1998-09-23
AU709928B2 (en) 1999-09-09
EP1036547A3 (de) 2000-12-27
WO1997018768A1 (en) 1997-05-29
EP1036547A2 (de) 2000-09-20
DE69626841D1 (de) 2003-04-24
EP1179320A3 (de) 2003-12-03

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